University of Washington, Seattle, WA.
Pfizer Inc, Bothell, WA.
JCO Clin Cancer Inform. 2024 Sep;8:e2400073. doi: 10.1200/CCI.24.00073.
Categorizing patients with cancer by their disease stage can be an important tool when conducting administrative claims-based studies. As claims databases frequently do not capture this information, algorithms are increasingly used to define disease stage. To our knowledge, to date, no study has used an algorithm to categorize patients with bladder cancer (BC) by disease stage (non-muscle-invasive BC [NMIBC], muscle-invasive BC [MIBC], or locally advanced/metastatic urothelial carcinoma [la/mUC]) in a US-based health care claims database.
A claims-based algorithm was developed to categorize patients by disease stage on the basis of the administrative claims portion of the SEER-Medicare linked data. The algorithm was validated against a reference SEER registry, and the algorithm's parameters were iteratively modified to improve its performance. Patients were included if they had an initial diagnosis of BC between January 2016 and December 2017 recorded in SEER registry data. Medicare claims data were available for these patients until December 31, 2019. The algorithm was evaluated by assessing percentage agreement, Cohen's kappa (κ), specificity, positive predictive value (PPV), and negative predictive value (NPV) against the SEER categorization.
A total of 15,484 patients with SEER-confirmed BC were included: 10,991 (71.0%) with NMIBC, 3,645 (23.5%) with MIBC, and 848 (5.5%) with la/mUC. After multiple rounds of algorithm optimization, the final algorithm had an agreement of 82.5% with SEER, with a κ of 0.58, a PPV of 87.0% for NMIBC, and 76.8% for MIBC and a high NPV for la/mUC of 98.0%.
This claims-based algorithm could be a useful approach for researchers conducting claims-based studies categorizing patients with BC at diagnosis.
在进行基于行政索赔的研究时，通过疾病阶段对癌症患者进行分类可能是一种重要的工具。由于索赔数据库通常无法捕获此信息，因此越来越多地使用算法来定义疾病阶段。据我们所知，迄今为止，尚无研究在基于美国医疗保健索赔数据库中使用算法对膀胱癌 (BC) 患者进行疾病阶段（非肌肉浸润性 BC [NMIBC]、肌肉浸润性 BC [MIBC] 或局部晚期/转移性尿路上皮癌 [la/mUC]）分类。
开发了一种基于索赔的算法，根据 SEER-Medicare 链接数据的行政索赔部分对患者进行疾病阶段分类。该算法针对 SEER 登记处进行了验证，并迭代修改算法参数以提高其性能。如果患者在 SEER 登记处数据中记录了 2016 年 1 月至 2017 年 12 月之间的初始 BC 诊断，则将其纳入研究。这些患者的 Medicare 索赔数据可用于 2019 年 12 月 31 日。该算法通过评估与 SEER 分类的百分比一致性、Cohen 的 kappa（κ）、特异性、阳性预测值 (PPV) 和阴性预测值 (NPV) 来进行评估。
共有 15484 名经 SEER 证实患有 BC 的患者被纳入研究：10991 名（71.0%）为 NMIBC，3645 名（23.5%）为 MIBC，848 名（5.5%）为 la/mUC。经过多轮算法优化，最终算法与 SEER 的一致性为 82.5%，κ 值为 0.58，NMIBC 的 PPV 为 87.0%，MIBC 的 PPV 为 76.8%，la/mUC 的 NPV 较高，为 98.0%。
这种基于索赔的算法可能是研究人员在进行基于索赔的研究时对诊断时的 BC 患者进行分类的有用方法。
